HomeMy WebLinkAbout23-9682 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
❑ ❑ FIRE ❑ CASE# 23-9682 2 0 7
INTERSTATE CITY STREET ✓ RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4100 3❑
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
2
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cawsloN 08 - 1-- 2023 1503 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
AIRPORT WAY
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e LAKEAVES
0 1 29
MOTUNIT U1 VEHICR Z PEDAL-CLE CYCLE ElYESA,G/ENHORESHOLDMET PHONE 0 7 30
6 LAST NAME CHEWAKA MATO FIRSTNAME ESAYAS MIDDLE N 1 1 2 31
INITIAL
STREET ❑ 9061 SEWARD PARK AVE S#5-38 CITY SEATTLE ST WA 7jp, 981185159 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YEs NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES 2❑
3
10 9❑ p7 LICENE 14 BSF8484 STATE WA VIN# JTDZN3EU9GJ045108
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM To
TRLR. TRLR 3 7 33
12 0 0 VIN#' VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE J 9 34
13 2 2016 TOYT PRIUS V DAMAGE vEs 0NO f �AWkkRS vEs❑ No✓
REGISTERED OWNER INFO ESAYAS CHEWAKA MA TO 1061 SEWARD PARK AVE S APT 5-SEATTLEWA98118 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ABILI V INSURANCE INSURANCE CO SAME. 3 4
IN EFFECT &POLICY# 9TOP
VEHCLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 3A0329705 INATTENTIVE DRIVING 1 o sorrow
15❑ STAIN.D'ING 7 6
UNIT VE IOOR CYCLE ❑PEDAL- PEDESTRIAN ❑ OWNER
711
DYES✓ NO OLD MET PHONE
16 a
LAST NAME GARCIA RUANO FIRST NAME DANIEL MIDDLE N
INITIAL
17❑ STREET ❑', 816 N 4TH ST APT 3 CITY' RENTON ST WA ZIP 980575456 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t t— l NO❑
19 DRIVER # STATE WA SEX M M .C... 07 05 _ 1984 El 39
20❑ ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 HELMET INJURY 7 NATURE OF INJURIES ❑ 40
USE CLASS KNEE
21❑ LICENSE I BPM5112 TATE WA VIN# 1Y1SK5286WZ417965
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 1998 MAKE CHEV MODEL GEO STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI �44
L4❑ DAMAGE YES NO✓ YES NO✓
REGISTERED OWNER INFO DANIEL GARCIA RUANO 816N4THSTAPT3 RENTON WA 98057 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
INAEFFIECTTY NSURANCE INSU&POLICY#E CO SAME. 1 9TOP
'E""LE CITATION# CHARGE
LEG
25 i o BOTTOM
ALLY YES Nu
❑ s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED97762
COLLISION REPORT III III III III III 111
1591972 CASE# 23-9682
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(LAST FIRST,MIDDLE INITIAL)_
ADDRESS&PHONE#
SEX D.O.B. - -
MMDDYYYY.
PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D D B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
silver suv/2 stopped 4 trfc unit1/slv prius rear ended
CC
Within the city limits of Renton/King/WA I responded to a 2 car blocking crash at the intersection of
Airport Way and Lake Ave S.
I contacted the driver of unit 2 who told me he was stopped facing westbound lane 1 when unit 1
crashed into the back of him. He did complain of injury and was checked/released on scene by
Renton Fire. Damages did not require a tow truck.
I contacted the driver of unit 1 ID'd by matching picture WADL. Unit 1 told me he did not realize traffic
was stopped in front of him when he rear-ended unit 2. He did not complain of injury and damages
required a tow truck.
I cited unit 1 ref RMC 10-12-25 Driver Inattention 2 car injury crash via complaint.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
M.Leverton/2517 City of Renton/King/Wa 8/23/2023
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 08-23-23 10:19 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 911112023 9:37:16 AM
BADGE OR ID# 2517 OR]# WA0171300 TIME POLICE DISPATCHED 3:03 PM TIME POLICE ARRIVED 3:09 PM
PART I PAGE IT]OF 3�
REPORT NO. ED97762 CASE# ' 23-9682 DATE AND TIME 08/22/23 15:03
OF COLLISION
rt1
nts
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